Large Versus Small Gastric Pouch for Roux-en-Y Gastric Bypass in Individuals With Type 2 Diabetes and a Body Mass Index < 35 kg/m2: Six-Year Outcomes

Abstract

BackgroundRoux-en-Y gastric bypass (RYGB) results in extraordinary weight loss and glycemic control outcomes for patients with obesity; however, the effect of gastric pouch size is still unclear, and the reported results are contradictory. Additionally, long-term data on type 2 diabetes (T2D) patients with low body mass index (BMI) are sparse. This study was to assess the effect of 6-year outcomes in Chinese patients with T2D and a BMI &amp;lt; 35 kg/m2 who underwent RYGB with gastric pouches of different sizes.MethodsA retrospective cohort study was performed. There were 42 patients in the large gastric pouch group (L) and 53 patients in the small gastric pouch group (S). Baseline demographic history, pre- and postoperative BMI, waist circumference, and glucose- and lipid metabolism-related indicators were compared.ResultsAssessments were completed in 100%, 100%, 93.6%, and 89.4% of patients at baseline, 1 year, 3 years, and 6 years, respectively. At 6 years, the changes in BMI and fasting plasma glucose were greater in the S group (-4.25 ± 0.51 kg/m2 and -4.58 ± 0.73 mmol/l) than in the L group (-2.06 ± 0.48 kg/m2 and -2.64 ± 0.61 mmol/l). The independent predictors of complete remission of T2D were preoperative BMI and the size of the gastric pouch. A large gastric pouch was associated with a higher risk for marginal ulcers.ConclusionsA small gastric pouch results in better weight loss and glycemic control. High preoperative BMI and a small gastric pouch are associated with better T2D remission rates. A large gastric pouch leads to a higher incidence of marginal ulcers.

Gut motility and hormone changes after bariatric procedures

“…The degree of change in gastric emptying can vary depending on postsurgical anatomical factors, including dimensions of the pouch and the width of the gastrojejunal anastomosis. In fact, some data suggest a smaller, rapid emptying gastric pouch may lead to improved weight loss and food tolerance after RYGB [72,73]. One study used high-resolution manometry to demonstrate that the Roux limb exhibits regular migrating motility complexes, suggesting that the gastric pouch and the Roux limb behave as a common cavity during food ingestion [74].…”

Marginal Ulcers after Roux-en-Y Gastric Bypass: Etiology, Diagnosis, and Management

“…MU formation is influenced by the size of the gastric pouch, as larger pouches contain a greater parietal cell mass that produces acid, resulting in increased acidity levels and a higher likelihood of developing ulcers [ 29 , 30 ]. It has been suggested that inflammation-inducing conditions and prolonged irritation from foreign materials, such as the use of non-absorbable suture material, staples leading to staple line dehiscence, and tension on the anastomosis, can increase the risk of MU.…”

Endoscopic reversal of roux-en-Y gastric bypass prevents worsening of nutritional outcomes in patients with severe malnutrition

“…The Roux-en-Y gastric bypass (RYGB) constitutes one of the most common and effective bariatric procedures performed in the treatment of obesity (1,2). During a RYGB, the receptive stomach is downsized to a small pouch the size of an egg (10-35ml) (3). The remaining portion of the stomach is no longer receptive to food and anastomosed to a proximal portion of the small intestine, the biliopancreatic limb.…”